title: A review on the article: role of common biochemical markers for the assessment of fracture union.
abstract: Criterion for patient selection and demographic comparison between the two groups, the numbers in individual groups (normal union or defective union) how the observers were blinded for the samples and control group measurements in the graphs were not mentioned. No data on actual measurement levels is given. No where it is mentioned like it is an average of all normal union or defective union in tables or diagrams. The treatment methodology maybe still focused including either conservative or surgical treatment since a displaced fracture cannot be compared with an osteotomy. The cases shall be followed up for a longer period. Some suggestions on how to blind the observers is given. In the one year period there was neither mention of the failure of treatment or complications of any of neither these 36 cases nor any drop out for follow-ups. There was also no mention of any case which initially put on conservation was changed to surgical management. The authors could have one group of patients taking this food stuff and another group who refused this food stuff. The statistical test used to compare the levels of factor is not mentioned. Mere statement that 'p' values were significant will not benefit the reader. Failure to produce X-rays even for a single case weakens the study. X-rays are needed to confirm the diagnosis of a fracture and confirm the position of implants and fracture fragments. The remaining period after confirming the fracture/implant position the case shall be followed only with marker estimation. Once the desired levels of increase or tapering of marker level achieved then X-rays can be taken to correlate with clinical findings and radiology. Union as one group and the second group shall be called as non-union or delayed union. The second group (the poor callus group) is mentioned as malunion possibly by over-sight. Probably they were meaning the non union or delayed union group or defective union as malunion. This should be preferably be written non union or delayed union. Malunion means the fracture actually unites and union process is completed. In a group of fractures (hypertrophic non unions) the callus formation is excessive, still the fracture is ununited. Thus the enzyme or markers alone cannot disclose the details of the completion of union they can herald bone formation.
authors.affiliation: Department of Orthopaedic Surgery, Government Thanjavur Medical College, Thanjavur, India.
authors.forename: Shanmugasundaram
authors.initials: S
authors.lastname: Kumaravel
keywords: Blinding; Malunion; Marker estimation; Non-union; X-rays